Massachusetts Teachers Association. Your Group Long Term Disability Plan

Transcription

1 Massachusetts Teachers Association Your Group Long Term Disability Plan Policy No Underwritten by Unum Life Insurance Company of America 8/4/2008

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3 CERTIFICATE OF COVERAGE Unum Life Insurance Company of America (referred to as Unum) welcomes you as a client. This is your certificate of coverage as long as you are eligible for coverage and you become insured. You will want to read it carefully and keep it in a safe place. Unum has written your certificate of coverage in plain English. However, a few terms and provisions are written as required by insurance law. If you have any questions about any of the terms and provisions, please consult Unum's claims paying office. Unum will assist you in any way to help you understand your benefits. If the terms and provisions of the certificate of coverage (issued to you) are different from the policy (issued to the policyholder), the policy will govern. Your coverage may be cancelled or changed in whole or in part under the terms and provisions of the policy. The policy is delivered in and is governed by the laws of the governing jurisdiction and to the extent applicable by the Employee Retirement Income Security Act of 1974 (ERISA) and any amendments. When making a benefit determination under the policy, Unum has discretionary authority to determine your eligibility for benefits and to interpret the terms and provisions of the policy. For purposes of effective dates and ending dates under the group policy, all days begin at 12:01 a.m. and end at 12:00 midnight at the Policyholder's address. Unum Life Insurance Company of America 2211 Congress Street Portland, Maine CC.FP-1 CC.FP-1 (8/1/2008) 1

4 TABLE OF CONTENTS BENEFITS AT A LONG TERM DISABILITY CLAIM INFORMATION...LTD-CLM-1 LONG TERM DISABILITY...LTD-CLM-1 GENERAL PROVISIONS...EMPLOYEE-1 LONG TERM DISABILITY...LTD-BEN-1 BENEFIT INFORMATION...LTD-BEN-1 OTHER BENEFIT FEATURES...LTD-OTR-1 OTHER SERVICES...SERVICES-1 GLOSSARY...GLOSSARY-1 TOC-1 (8/1/2008) 2

5 BENEFITS AT A GLANCE LONG TERM DISABILITY PLAN This long term disability plan provides financial protection for you by paying a portion of your income while you are disabled. The amount you receive is based on the amount you earned before your disability began and the monthly benefit option that you chose. In some cases, you can receive disability payments even if you work while you are disabled. POLICYHOLDER'S ORIGINAL PLAN EFFECTIVE DATE: July 1, 2001 PLAN YEAR: July 1, 2001 to July 1, 2002 and each following July 1 to July 1 POLICY NUMBER: ELIGIBLE GROUP(S): Class I: You are eligible for coverage under this plan if you are: a) a member of the Massachusetts Teachers Association; b) employed by a School Department or School Committee in the Commonwealth of Massachusetts which remits your premium, post tax, on a salary reduction basis; and c) you are actively employed full-time or part-time for at least 18.5 hours per week in the United States with your Employer. Class II (CLOSED CLASS): You are eligible for coverage under this plan if you were: a) covered under the prior plan as a direct bill participant prior to July 1, 2001; or b) covered under the prior plan and whose Board of Education or School Committee will not allow premium reduction or remittance as of July 1, 2001 in active employment in the United States with the Employer WAITING PERIOD: For employees in an eligible group on or before July 1, 2001: None For employees entering an eligible group after July 1, 2001: None WHO PAYS FOR THE COVERAGE: If your coverage was effective on or after July 1, 2003 Option A No Coverage Option B Either you pay the cost of your coverage or you and your Employer share the cost of your coverage. If your coverage was effective prior to July 1, 2003 Option A No Coverage Option B Either you pay the cost of your coverage or you and your Employer share the cost of your coverage. (8/1/2008) 3

6 Option C Either you pay the cost of your coverage or you and your Employer share the cost of your coverage. Option D Either you pay the cost of your coverage or you and your Employer share the cost of your coverage. ELIMINATION PERIOD: The later of: days; or - the date your insured Short Term Disability payments end, if applicable. Benefits begin the day after the elimination period is completed. MONTHLY BENEFIT: If your coverage was effective on or after July 1, 2003 Option A No Coverage Option B 60% of monthly earnings to a maximum benefit of $5,000 per month. Your payment may be reduced by deductible sources of income and disability earnings. Some disabilities may not be covered or may have limited coverage under this plan. If your coverage was effective prior to July 1, 2003 Option A No Coverage Option B 40% of monthly earnings to a maximum benefit of $1,500 per month. Your payment may be reduced by deductible sources of income and disability earnings. Some disabilities may not be covered or may have limited coverage under this plan. Option C 50% of monthly earnings to a maximum benefit of $2,250 per month. Your payment may be reduced by deductible sources of income and disability earnings. Some disabilities may not be covered or may have limited coverage under this plan. Option D 60% of monthly earnings to a maximum benefit of $5,000 per month. Your payment may be reduced by deductible sources of income and disability earnings. Some disabilities may not be covered or may have limited coverage under this plan. MAXIMUM PERIOD OF PAYMENT: Age at Disability Less than age 60 Age 60 Maximum Period of Payment To age 65, but not less than 5 years 60 months (8/1/2008) 4

7 Age 61 Age 62 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and over 48 months 42 months 36 months 30 months 24 months 21 months 18 months 15 months 12 months No premium payments are required for your coverage while you are receiving payments under this plan. REHABILITATION AND RETURN TO WORK ASSISTANCE BENEFIT: 10% of your gross disability payment to a maximum benefit of $1,000 per month. In addition, we will make monthly payments to you for 3 months following the date your disability ends if we determine you are no longer disabled while: - you are participating in the Rehabilitation and Return to Work Assistance program; and - you are not able to find employment. CHILD CARE EXPENSE BENEFIT: While you are participating in Unum's Rehabilitation and Return to Work Assistance program, you may receive payments to cover certain child care expenses limited to the following amounts: Child Care Expense Benefit Amount: $250 per month, per child Child Care Expense Maximum Benefit Amount: $1,000 per month for all eligible child care expenses combined TOTAL BENEFIT CAP: The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings. OTHER FEATURES: Continuity of Coverage Conversion Minimum Benefit Pre-Existing: 12/12 Survivor Benefit Work Life Assistance Program The above items are only highlights of this plan. For a full description of your coverage, continue reading your certificate of coverage section. (8/1/2008) 5

8 CLAIM INFORMATION LONG TERM DISABILITY WHEN DO YOU NOTIFY UNUM OF A CLAIM? We encourage you to notify us of your claim as soon as possible, so that a claim decision can be made in a timely manner. Written notice of a claim should be sent within 30 days after the date your disability begins. However, you must send Unum written proof of your claim no later than 90 days after your elimination period. If it is not possible to give proof within 90 days, it must be given no later than 1 year after the time proof is otherwise required except in the absence of legal capacity. The claim form is available from MTA Benefits, Inc., or you can request a claim form from us. If you do not receive the form from Unum within 15 days of your request, send Unum written proof of claim without waiting for the form. You must notify us immediately when you return to work in any capacity. HOW DO YOU FILE A CLAIM? You and your Employer must fill out your own sections of the claim form and then give it to your attending physician. Your physician should fill out his or her section of the form and send it directly to Unum. WHAT INFORMATION IS NEEDED AS PROOF OF YOUR CLAIM? Your proof of claim, provided at your expense, must show: - that you are under the regular care of a physician; - the appropriate documentation of your monthly earnings; - the date your disability began; - the cause of your disability; - the extent of your disability, including restrictions and limitations preventing you from performing your regular occupation; and - the name and address of any hospital or institution where you received treatment, including all attending physicians. We may request that you send proof of continuing disability indicating that you are under the regular care of a physician. This proof, provided at your expense, must be received within 45 days of a request by us. In some cases, you will be required to give Unum authorization to obtain additional medical information and to provide non-medical information as part of your proof of claim, or proof of continuing disability. Unum will deny your claim, or stop sending you payments, if the appropriate information is not submitted. TO WHOM WILL UNUM MAKE PAYMENTS? Unum will make payments to you. LTD-CLM-1 (8/1/2008) 6

9 WHAT HAPPENS IF UNUM OVERPAYS YOUR CLAIM? Unum has the right to recover any overpayments due to: - fraud; - any error Unum makes in processing a claim; and - your receipt of deductible sources of income. You must reimburse us in full. We will determine the method by which the repayment is to be made. Unum will not recover more money than the amount we paid you. LTD-CLM-2 (8/1/2008) 7

10 GENERAL PROVISIONS WHAT IS THE CERTIFICATE OF COVERAGE? This certificate of coverage is a written statement prepared by Unum and may include attachments. It tells you: - the coverage for which you may be entitled; - to whom Unum will make a payment; and - the limitations, exclusions and requirements that apply within a plan. WHEN ARE YOU ELIGIBLE FOR COVERAGE? If you are working for your Employer in an eligible group, the date you are eligible for coverage is the later of: - the plan effective date; or - the day after you complete your waiting period. WHEN DOES YOUR COVERAGE BEGIN? This plan provides different benefit options. When you first become eligible for coverage, you may apply for any option, however, you cannot be covered under more than one option at a time. Either you pay 100% of the cost of your coverage or you and your Employer share the cost of your coverage. You can decline coverage when you first become eligible which is Option A, or apply for coverage by choosing another option. Coverage will begin at 12:01 a.m. on the date you are eligible for coverage, if you apply for insurance on or before that date. If you first become eligible for coverage after the plan effective date, you will be covered at 12:01 a.m. on the latest of: - the date you are eligible for coverage, if you apply for insurance on or before that date; or - the date you apply for insurance, if you apply within 60 days after your eligibility date; or - the first day of the period for which you made any required contributions. WHEN CAN YOU ELECT COVERAGE IF YOU DECLINED COVERAGE WHEN YOU FIRST BECAME ELIGIBLE OR IF YOU VOLUNTARILY CANCELLED YOUR COVERAGE? (Late Entrants) If your coverage was effective on or after July 1, 2003 You can elect coverage only during an annual enrollment period or within 31 days of a change in status. If you previously declined coverage when you first became eligible or voluntarily cancelled your coverage, you may elect only Option B coverage. Unum and your Employer determine when the annual enrollment period begins and ends. Coverage will begin at 12:01 a.m. on the first day of the next plan year. EMPLOYEE-1 (8/1/2008) 8

11 If you apply for coverage due to a change in status, your coverage will begin at 12:01 a.m. on the latest of: - the date of the change in status, if you apply on or before that date; or - the date you apply, if you apply within 31 days after the date of the change in status; or - the first day of the period for which you made any required contributions. Changes in coverage must be consistent with the change in status. If your coverage was effective prior to July 1, 2003 You can elect coverage only during an annual enrollment period or within 31 days of a change in status. If you previously declined coverage when you first became eligible or voluntarily cancelled your coverage, you may elect only Option D coverage. Unum and your Employer determine when the annual enrollment period begins and ends. Coverage will begin at 12:01 a.m. on the first day of the next plan year. If you apply for coverage due to a change in status, your coverage will begin at 12:01 a.m. on the latest of: - the date of the change in status, if you apply on or before that date; or - the date you apply, if you apply within 31 days after the date of the change in status; or - the first day of the period for which you made any required contributions. Changes in coverage must be consistent with the change in status. WHEN CAN YOU CHANGE YOUR COVERAGE BY CHOOSING ANOTHER OPTION? (This does not apply to Late Entrants) If your coverage was effective prior to July 1, 2003 You can change your coverage by applying for Option D only during an annual enrollment period or within 31 days of a change in status. If you increase your coverage to Option D from Option B or Option C you may not re-enroll in Option B or Option C. Unum and the Policyholder determine when the annual enrollment period begins and ends. A change in coverage that is made during an annual enrollment period will begin at 12:01 a.m. on the first day of the next plan year. A change in coverage due to a change in status will begin at 12:01 a.m. on the latest of: - the date of the change in status, if you apply on or before that date; - the date you apply, if you apply within 31 days after the date of the change in status; or - the first day of the period for which you made required contributions. EMPLOYEE-2 (8/1/2008) 9

12 Changes in coverage must be consistent with the change in status. If you end employment and are rehired within the same plan year, you may be insured on your eligibility date for the coverage that you had under the plan when you ended employment. You cannot change your coverage until the next annual enrollment period or change in status. WHAT IF YOU ARE ABSENT FROM WORK ON THE DATE YOUR COVERAGE WOULD NORMALLY BEGIN? If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will begin on the date you return to active employment. ONCE YOUR COVERAGE BEGINS, WHAT HAPPENS IF YOU ARE TEMPORARILY NOT WORKING? If you are on a temporary layoff, and if premium is paid, you will be covered through the end of the month that immediately follows the month in which your temporary layoff begins. If you are on a sabbatical leave of absence, and if premium is paid, you will be covered for up to 1 year following the date your sabbatical leave of absence begins. If you are on any other leave of absence, and if premium is paid, you will be covered through the end of the month that immediately follows the month in which your leave of absence begins. ONCE YOUR COVERAGE BEGINS, WHAT HAPPENS IF YOU ARE NOT WORKING DUE TO A PLANT CLOSING? If you are not working due to a plant closing (as defined in Section 71A of Chapter 151A of the Massachusetts Insurance Statutes), and if premium is paid, you will be covered up to 90 days from the date you were no longer in active employment. If you become covered under any other group disability plan, your coverage under this policy or plan will end. WHEN WILL CHANGES TO YOUR COVERAGE TAKE EFFECT? Once your coverage begins, any increased or additional coverage due to a change in your weekly/monthly earnings or due to a plan change requested by the Policyholder will take effect on the later of the following dates if you are in active employment or if you are on a covered layoff or leave of absence: - the effective date of the change in your weekly/monthly earnings; - the effective date of the plan change; or - the first day of the period for which you made contributions for the change in coverage. If you are not in active employment due to injury or sickness, any increased or additional coverage will begin on the later of: - date you return to active employment; or EMPLOYEE-3 (8/1/2008) 10

13 - the first day of the period for which you made contributions for the change in coverage. Any decrease in coverage will take effect immediately but will not affect a payable claim that occurs prior to the decrease. WHEN DOES YOUR COVERAGE END? Your coverage under the policy or a plan ends on the earliest of: - the date the policy or a plan is cancelled; - the date you no longer are in an eligible group; - the date your eligible group is no longer covered; - the last day of the period for which you made any required contributions; - the date you cease to be a member in good standing of the Massachusetts Teachers Association; or - the last day you are in active employment except as provided under the covered layoff, leave of absence and plant closing provisions, or as noted below. If you end employment, coverage will be extended for 31 days. But if you become eligible for any other group disability insurance or any other arrangement, this extension of coverage will end. Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan. WHAT ARE THE TIME LIMITS FOR LEGAL PROCEEDINGS? You can start legal action regarding your claim 60 days after proof of claim has been given and up to 3 years from the time proof of claim is required, unless otherwise provided under federal law. HOW CAN STATEMENTS MADE IN YOUR APPLICATION FOR THIS COVERAGE BE USED? Unum considers any statements made by you, your Employer or the Policyholder in a signed application for coverage a representation and not a warranty. If any of the statements made by you, your Employer or the Policyholder are not complete and/or not true at the time they are made, we can: - reduce or deny any claim; or - cancel your coverage from the original effective date. We will use only statements made in a signed application as a basis for doing this. If the Employer or the Policyholder gives us information about you that is incorrect, we will: - use the facts to decide whether you have coverage under the plan and in what amounts; and - make a fair adjustment of the premium. EMPLOYEE-4 (8/1/2008) 11

14 HOW WILL UNUM HANDLE INSURANCE FRAUD? Unum wants to ensure you and the Policyholder do not incur additional insurance costs as a result of the undermining effects of insurance fraud. Unum promises to focus on all means necessary to support fraud detection, investigation, and prosecution. It is a crime if you knowingly, and with intent to injure, defraud or deceive Unum, or provide any information, including filing a claim, that contains any false, incomplete or misleading information. These actions, as well as submission of materially false information, will result in denial of your claim, and are subject to prosecution and punishment to the full extent under state and/or federal law. Unum will pursue all appropriate legal remedies in the event of insurance fraud. DOES THE POLICY REPLACE OR AFFECT ANY WORKERS' COMPENSATION OR STATE DISABILITY INSURANCE? The policy does not replace or affect the requirements for coverage by any workers' compensation or state disability insurance. DOES THE POLICYHOLDER ACT AS YOUR AGENT OR UNUM'S AGENT? For purposes of the policy, the Policyholder acts on its own behalf or as your agent. Under no circumstances will the Policyholder be deemed the agent of Unum. DOES YOUR EMPLOYER ACT AS YOUR AGENT OR UNUM'S AGENT? For purposes of the policy, your Employer acts on its own behalf or as your agent. Under no circumstances will your Employer be deemed the agent of Unum. EMPLOYEE-5 (8/1/2008) 12

15 HOW DOES UNUM DEFINE DISABILITY? LONG TERM DISABILITY BENEFIT INFORMATION You are disabled when Unum determines that: - you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and - you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury. After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. The loss of a professional or occupational license or certification does not, in itself, constitute disability. We may require you to be examined by a physician, other medical practitioner and/or vocational expert of our choice. Unum will pay for this examination. We can require an examination as often as it is reasonable to do so. We may also require you to be interviewed by an authorized Unum Representative. HOW LONG MUST YOU BE DISABLED BEFORE YOU ARE ELIGIBLE TO RECEIVE BENEFITS? You must be continuously disabled through your elimination period. Unum will treat your disability as continuous if your disability stops for 30 days or less during the elimination period. The days that you are not disabled will not count toward your elimination period. Your elimination period is the later of: days; or - the date your insured Short Term Disability payments end, if applicable. CAN YOU SATISFY YOUR ELIMINATION PERIOD IF YOU ARE WORKING? Yes. If you are working while you are disabled, the days you are disabled will count toward your elimination period. WHEN WILL YOU BEGIN TO RECEIVE PAYMENTS? You will begin to receive payments when we approve your claim, providing the elimination period has been met and you are disabled. We will send you a payment monthly for any period for which Unum is liable. LTD-BEN-1 (8/1/2008) 13

16 HOW MUCH WILL UNUM PAY YOU IF YOU ARE DISABLED? We will follow this process to figure your payment: If your coverage was effective on or after July 1, 2003 OPTION A No Coverage OPTION B 1. Multiply your monthly earnings by 60%. 2. The maximum monthly benefit is $5, Compare the answer from Item 1 with the maximum monthly benefit. The lesser of these two amounts is your gross disability payment. 4. Subtract from your gross disability payment any deductible sources of income. The amount figured in Item 4 is your monthly payment. If your coverage was effective prior to July 1, 2003 OPTION A No Coverage OPTION B 1. Multiply your monthly earnings by 40%. 2. The maximum monthly benefit is $1, Compare the answer from Item 1 with the maximum monthly benefit. The lesser of these two amounts is your gross disability payment. 4. Subtract from your gross disability payment any deductible sources of income. The amount figured in Item 4 is your monthly payment. OPTION C 1. Multiply your monthly earnings by 50%. 2. The maximum monthly benefit is $2, Compare the answer from Item 1 with the maximum monthly benefit. The lesser of these two amounts is your gross disability payment. 4. Subtract from your gross disability payment any deductible sources of income. The amount figured in Item 4 is your monthly payment. OPTION D 1. Multiply your monthly earnings by 60%. 2. The maximum monthly benefit is $5, Compare the answer from Item 1 with the maximum monthly benefit. The lesser of these two amounts is your gross disability payment. 4. Subtract from your gross disability payment any deductible sources of income. The amount figured in Item 4 is your monthly payment. LTD-BEN-2 (8/1/2008) 14

17 WILL UNUM EVER PAY MORE THAN 100% OF MONTHLY EARNINGS? The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings. WHAT ARE YOUR MONTHLY EARNINGS? Teachers: "Monthly Earnings" means the following amount: 1/12th of your annual teachers contract salary in effect just prior to your date of disability. Annual salary is your total income before taxes and any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan or flexible spending account. It does not include income received from commissions, bonuses, overtime pay, shift differential or any other extra compensation, or income received from sources other than your Employer. All members other than teachers: "Monthly Earnings" means your gross monthly income from your Employer in effect just prior to your date of disability. It includes your total income before taxes. It is prior to any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It does not include income received from commissions, bonuses, overtime pay, shift differential or any other extra compensation, or income received from sources other than your Employer. WHAT WILL WE USE FOR MONTHLY EARNINGS IF YOU BECOME DISABLED DURING A COVERED LAYOFF OR LEAVE OF ABSENCE? If you become disabled while you are on a covered layoff or leave of absence, we will use your monthly earnings from your Employer in effect just prior to the date your absence begins. HOW MUCH WILL UNUM PAY YOU IF YOU ARE DISABLED AND WORKING? We will send you the monthly payment if you are disabled and your monthly disability earnings, if any, are less than 20% of your indexed monthly earnings, due to the same sickness or injury. If you are disabled and your monthly disability earnings are from 20% through 80% of your indexed monthly earnings, due to the same sickness or injury, Unum will figure your payment as follows: During the first 12 months of payments, while working, your monthly payment will not be reduced as long as disability earnings plus the gross disability payment does not exceed 100% of indexed monthly earnings. 1. Add your monthly disability earnings to your gross disability payment. 2. Compare the answer in Item 1 to your indexed monthly earnings. LTD-BEN-3 (8/1/2008) 15

18 If the answer from Item 1 is less than or equal to 100% of your indexed monthly earnings, Unum will not further reduce your monthly payment. If the answer from Item 1 is more than 100% of your indexed monthly earnings, Unum will subtract the amount over 100% from your monthly payment. After 12 months of payments, while working, you will receive payments based on the percentage of income you are losing due to your disability. 1. Subtract your disability earnings from your indexed monthly earnings. 2. Divide the answer in Item 1 by your indexed monthly earnings. This is your percentage of lost earnings. 3. Multiply your monthly payment by the answer in Item 2. This is the amount Unum will pay you each month. Unum may require you to send proof of your monthly disability earnings at least quarterly. We will adjust your payment based on your quarterly disability earnings. As part of your proof of disability earnings, we can require that you send us appropriate financial records which we believe are necessary to substantiate your income. After the elimination period, if you are disabled for less than 1 month, we will send you 1/30 of your payment for each day of disability. HOW CAN WE PROTECT YOU IF YOUR DISABILITY EARNINGS FLUCTUATE? If your disability earnings routinely fluctuate widely from month to month, Unum may average your disability earnings over the most recent 3 months to determine if your claim should continue. If Unum averages your disability earnings, we will not terminate your claim unless the average of your disability earnings from the last 3 months exceeds 80% of indexed monthly earnings. We will not pay you for any month during which disability earnings exceed 80% of indexed monthly earnings. WHAT ARE DEDUCTIBLE SOURCES OF INCOME? Unum will subtract from your gross disability payment the following deductible sources of income: 1. The amount that you receive or are entitled to receive under: - a workers' compensation law. - an occupational disease law. - any other act or law with similar intent. 2. The amount that you receive or are entitled to receive as disability income payments under any: - state compulsory benefit act or law. LTD-BEN-4 (8/1/2008) 16

19 - automobile liability insurance policy. - other group insurance plan. - governmental retirement system as a result of your job with your Employer. 3. The amount that you, your spouse and your children receive or are entitled to receive as disability payments because of your disability under: - the United States Social Security Act. - the Canada Pension Plan. - the Quebec Pension Plan. - any similar plan or act. 4. The amount that you receive as retirement payments or the amount your spouse and children receive as retirement payments because you are receiving retirement payments under: - the United States Social Security Act. - the Canada Pension Plan. - the Quebec Pension Plan. - any similar plan or act. 5. The amount that you: - receive as disability payments under your Employer's retirement plan. - voluntarily elect to receive as retirement payments under your Employer's retirement plan. - receive as retirement payments when you reach the later of age 62 or normal retirement age, as defined in your Employer's retirement plan. Disability payments under a retirement plan will be those benefits which are paid due to disability and do not reduce the retirement benefit which would have been paid if the disability had not occurred. Retirement payments will be those benefits which are based on your Employer's contribution to the retirement plan. Disability benefits which reduce the retirement benefit under the plan will also be considered as a retirement benefit. Regardless of how the retirement funds from the retirement plan are distributed, Unum will consider your and your Employer's contributions to be distributed simultaneously throughout your lifetime. Amounts received do not include amounts rolled over or transferred to any eligible retirement plan. Unum will use the definition of eligible retirement plan as defined in Section 402 of the Internal Revenue Code including any future amendments which affect the definition. 6. The amount that you receive under Title 46, United States Code Section 688 (The Jones Act). 7. The amount that you receive from a third party (after subtracting attorney's fees) by judgment, settlement or otherwise. With the exception of retirement payments, Unum will only subtract deductible sources of income which are payable as a result of the same disability. LTD-BEN-5 (8/1/2008) 17

20 We will not reduce your payment by your Social Security retirement income if your disability begins after age 65 and you were already receiving Social Security retirement payments. WHAT ARE NOT DEDUCTIBLE SOURCES OF INCOME? Unum will not subtract from your gross disability payment income you receive from, but not limited to, the following: - 401(k) plans - profit sharing plans - thrift plans - tax sheltered annuities - stock ownership plans - non-qualified plans of deferred compensation - pension plans for partners - military pension and disability income plans - credit disability insurance - franchise disability income plans - a retirement plan from another Employer - individual retirement accounts (IRA) - individual disability income plans - salary continuation or accumulated sick leave plans WHAT IF SUBTRACTING DEDUCTIBLE SOURCES OF INCOME RESULTS IN A ZERO BENEFIT? (Minimum Benefit) The minimum monthly payment is the greater of: - $100; or - 10% of your gross disability payment. Unum may apply this amount toward an outstanding overpayment. WHAT HAPPENS WHEN YOU RECEIVE A COST OF LIVING INCREASE FROM DEDUCTIBLE SOURCES OF INCOME? Once Unum has subtracted any deductible source of income from your gross disability payment, Unum will not further reduce your payment due to a cost of living increase from that source. WHAT IF UNUM DETERMINES YOU MAY QUALIFY FOR DEDUCTIBLE INCOME BENEFITS? When we determine that you may qualify for benefits under Item(s) 1, 2 and 3 in the deductible sources of income section, we will estimate your entitlement to these benefits. We can reduce your payment by the estimated amounts if such benefits: - have not been awarded; and - have not been denied; or - have been denied and the denial is being appealed. LTD-BEN-6 (8/1/2008) 18

21 Your Long Term Disability payment will NOT be reduced by the estimated amount if you: - apply for the disability payments under Item(s) 1, 2 and 3 in the deductible sources of income section and appeal your denial to all administrative levels Unum feels are necessary; and - sign Unum's payment option form. This form states that you promise to pay us any overpayment caused by an award. If your payment has been reduced by an estimated amount, your payment will be adjusted when we receive proof: - of the amount awarded; or - that benefits have been denied and all appeals Unum feels are necessary have been completed. In this case, a lump sum refund of the estimated amount will be made to you. If you receive a lump sum payment from any deductible sources of income, the lump sum will be pro-rated on a monthly basis over the time period for which the sum was given. If no time period is stated, we will use a reasonable one. HOW LONG WILL UNUM CONTINUE TO SEND YOU PAYMENTS? Unum will send you a payment each month up to the maximum period of payment. Your maximum period of payment is based on your age at disability as follows: Age at Disability Less than age 60 Age 60 Age 61 Age 62 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and over Maximum Period of Payment To age 65, but not less than 5 years 60 months 48 months 42 months 36 months 30 months 24 months 21 months 18 months 15 months 12 months WHEN WILL PAYMENTS STOP? We will stop sending you payments and your claim will end on the earliest of the following: - during the first 24 months of payments, when you are able to work in your regular occupation on a part-time basis but you choose not to; - after 24 months of payments, when you are able to work in any gainful occupation on a part-time basis but you choose not to; - if you are working and your monthly disability earnings exceed 80% of your indexed monthly earnings, the date your earnings exceed 80%; - the end of the maximum period of payment; LTD-BEN-7 (8/1/2008) 19

22 - the date you are no longer disabled under the terms of the plan, unless you are eligible to receive benefits under Unum's Rehabilitation and Return to Work Assistance program; - the date you fail to cooperate or participate in Unum's Rehabilitation and Return to Work Assistance program; - the date you fail to submit proof of continuing disability; - after 12 months of payments if you are considered to reside outside the United States or Canada. You will be considered to reside outside these countries when you have been outside the United States or Canada for a total period of 6 months or more during any 12 consecutive months of benefits; - the date you die. WHAT DISABILITIES HAVE A LIMITED PAY PERIOD UNDER YOUR PLAN? Disabilities, due to sickness or injury, which are primarily based on self-reported symptoms, and disabilities due to mental illness have a limited pay period up to 24 months. Unum will continue to send you payments beyond the 24 month period if you meet one or both of these conditions: 1. If you are confined to a hospital or institution at the end of the 24 month period, Unum will continue to send you payments during your confinement. If you are still disabled when you are discharged, Unum will send you payments for a recovery period of up to 90 days. If you become reconfined at any time during the recovery period and remain confined for at least 14 days in a row, Unum will send payments during that additional confinement and for one additional recovery period up to 90 more days. 2. In addition to Item 1, if, after the 24 month period for which you have received payments, you continue to be disabled and subsequently become confined to a hospital or institution for at least 14 days in a row, Unum will send payments during the length of the reconfinement. Unum will not pay beyond the limited pay period as indicated above, or the maximum period of payment, whichever occurs first. Unum will not apply the mental illness limitation to dementia if it is a result of: - stroke; - trauma; - viral infection; - Alzheimer's disease; or - other conditions not listed which are not usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment. LTD-BEN-8 (8/1/2008) 20

23 WHAT DISABILITIES ARE NOT COVERED UNDER YOUR PLAN? Your plan does not cover any disabilities caused by, contributed to by, or resulting from your: - intentionally self-inflicted injuries. - active participation in a riot. - loss of a professional license, occupational license or certification. - commission of a crime for which you have been convicted under state or federal law. - pre-existing condition. Your plan will not cover a disability due to war, declared or undeclared, or any act of war. Unum will not pay a benefit for any period of disability during which you are incarcerated. WHAT IS A PRE-EXISTING CONDITION? You have a pre-existing condition when you apply for coverage when you first become eligible if: - you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 12 months just prior to your effective date of coverage; or you had symptoms for which an ordinarily prudent person would have consulted a health care provider in the 12 months just prior to your effective date of coverage; and - the disability begins in the first 12 months after your effective date of coverage. In addition, this plan will not cover an increase in your coverage made at an annual enrollment period or change in status if you have a pre-existing condition. You have a pre-existing condition if: - you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to the date your coverage increased; or you had symptoms for which an ordinarily prudent person would have consulted a health care provider in the 3 months just prior to the date your coverage increased; and - the disability begins in the first 12 months after your coverage increased. WHAT HAPPENS IF YOU RETURN TO WORK FULL TIME AND YOUR DISABILITY OCCURS AGAIN? If you have a recurrent disability, Unum will treat your disability as part of your prior claim and you will not have to complete another elimination period if: - you were continuously insured under the plan for the period between your prior claim and your recurrent disability; and - your recurrent disability occurs within 6 months of the end of your prior claim. Your recurrent disability will be subject to the same terms of this plan as your prior claim. LTD-BEN-9 (8/1/2008) 21

24 Any disability which occurs after 6 months from the date your prior claim ended will be treated as a new claim. The new claim will be subject to all of the policy provisions. If you become entitled to payments under any other group long term disability plan, you will not be eligible for payments under the Unum plan. LTD-BEN-10 (8/1/2008) 22

25 LONG TERM DISABILITY OTHER BENEFIT FEATURES WHAT BENEFITS WILL BE PROVIDED TO YOUR FAMILY IF YOU DIE? (Survivor Benefit) When Unum receives proof that you have died, we will pay your eligible survivor a lump sum benefit equal to 3 months of your gross disability payment if, on the date of your death: - your disability had continued for 180 or more consecutive days; and - you were receiving or were entitled to receive payments under the plan. If you have no eligible survivors, payment will be made to your estate, unless there is none. In this case, no payment will be made. However, we will first apply the survivor benefit to any overpayment which may exist on your claim. WHAT IF YOU ARE NOT IN ACTIVE EMPLOYMENT WHEN THE POLICYHOLDER CHANGES INSURANCE CARRIERS TO UNUM? (Continuity of Coverage) When the plan becomes effective, Unum will provide coverage for you if: - you are not in active employment because of a sickness or injury; and - you were covered by the prior policy. Your coverage is subject to payment of premium. Your payment will be limited to the amount that would have been paid by the prior carrier. Unum will reduce your payment by any amount for which your prior carrier is liable. WHAT IF YOU HAVE A DISABILITY DUE TO A PRE-EXISTING CONDITION WHEN THE POLICYHOLDER CHANGES INSURANCE CARRIERS TO UNUM? (Continuity of Coverage) Unum may send a payment if your disability results from a pre-existing condition if, you were: - in active employment and insured under the plan on its effective date; and - insured by the prior policy at the time of change. In order to receive a payment you must satisfy the pre-existing condition provision under: 1. the Unum plan; or 2. the prior carrier's plan, if benefits would have been paid had that policy remained in force. If you do not satisfy Item 1 or 2 above, Unum will not make any payments. LTD-OTR-1 (8/1/2008) 23

26 If you satisfy Item 1, we will determine your payments according to the Unum plan provisions. If you only satisfy Item 2, we will administer your claim according to the Unum plan provisions. However, your payment will be the lesser of: a. the monthly benefit that would have been payable under the terms of the prior plan if it had remained inforce; or b. the monthly payment under the Unum plan. Your benefits will end on the earlier of the following dates: 1. the end of the maximum benefit period under the plan; or 2. the date benefits would have ended under the prior plan if it had remained in force. WHAT INSURANCE IS AVAILABLE IF YOU END EMPLOYMENT? (Conversion) If you end employment with your Employer, your coverage under the plan will end. You may be eligible to purchase insurance under Unum's group conversion policy. To be eligible, you must have been insured under the Policyholder's group plan for at least 12 consecutive months. We will consider the amount of time you were insured under the Unum plan and the plan it replaced, if any. You must apply for insurance under the conversion policy and pay the first quarterly premium within 31 days after the date your employment ends. Unum will determine the coverage you will have under the conversion policy. The conversion policy may not be the same coverage we offered you under the Policyholder's group plan. You are not eligible to apply for coverage under Unum's group conversion policy if: - you are or become insured under another group long term disability plan within 31 days after your employment ends; - you are disabled under the terms of the plan; - you recover from a disability and do not return to work for your Employer; - you are on a leave of absence; or - your coverage under the plan ends for any of the following reasons: the plan is cancelled; the plan is changed to exclude the group of employees to which you belong; you are no longer in an eligible group; you end your working career or retire and receive payment from any Employer's retirement plan; or you fail to pay the required premium under this plan. HOW CAN UNUM'S REHABILITATION AND RETURN TO WORK ASSISTANCE PROGRAM HELP YOU RETURN TO WORK? Unum has a vocational Rehabilitation and Return to Work Assistance program available to assist you in returning to work. We will determine whether you are eligible for this program, at our sole discretion. In order to be eligible for rehabilitation services and benefits, you must be medically able to engage in a return to work program. LTD-OTR-2 (8/1/2008) 24

27 Your claim file will be reviewed by one of Unum's rehabilitation professionals to determine if a rehabilitation program might help you return to gainful employment. As your file is reviewed, medical and vocational information will be analyzed to determine an appropriate return to work program. If we determine you are eligible to participate in a Rehabilitation and Return to Work Assistance program, you must participate in order to receive disability benefits. We will make the final determination of your eligibility for participation in the program. We will provide you with a written Rehabilitation and Return to Work Assistance plan developed specifically for you. You must comply with the terms of the Rehabilitation and Return to Work Assistance plan in order to receive disability benefits. The rehabilitation program may include at our sole discretion, but is not limited to, the following services and benefits: - coordination with your Employer to assist you to return to work; - adaptive equipment or job accommodations to allow you to work; - vocational evaluation to determine how your disability may impact your employment options; - job placement services; - resume preparation; - job seeking skills training; or - education and retraining expenses for a new occupation. WHAT ADDITIONAL BENEFITS WILL UNUM PAY WHILE YOU PARTICIPATE IN A REHABILITATION AND RETURN TO WORK ASSISTANCE PROGRAM? We will pay an additional disability benefit of 10% of your gross disability payment to a maximum benefit of $1,000 per month. This benefit is not subject to policy provisions which would otherwise increase or reduce the benefit amount such as Deductible Sources of Income. However, the Total Benefit Cap will apply. In addition, we will make monthly payments to you for 3 months following the date your disability ends if we determine you are no longer disabled while: - you are participating in the Rehabilitation and Return to Work Assistance program; and - you are not able to find employment. This benefit payment may be paid in a lump sum. WHEN WILL REHABILITATION AND RETURN TO WORK ASSISTANCE BENEFITS END? Benefit payments will end on the earliest of the following dates: - the date Unum determines that you are no longer eligible to participate in Unum's Rehabilitation and Return to Work Assistance program; or - any other date on which monthly payments would stop in accordance with this plan. LTD-OTR-3 (8/1/2008) 25

28 WHAT ADDITIONAL BENEFIT IS AVAILABLE FOR CHILD CARE EXPENSES IF YOU ARE PARTICIPATING IN UNUM'S REHABILITATION AND RETURN TO WORK ASSISTANCE PROGRAM? When you are disabled and incurring child care expenses for your dependent child(ren) and participating continuously in Unum's Rehabilitation and Return to Work Assistance program, we will pay the Child Care Expense Benefit Amount. The payment of the Child Care Expense Benefit Amount will begin immediately after you start Unum's rehabilitation program. CHILD CARE EXPENSE BENEFIT AMOUNT Our payment of the Child Care Expense Benefit Amount will: 1. be $250 per month, per child; and 2. not exceed $1,000 per month for all eligible child care expenses combined. CHILD CARE EXPENSE BENEFIT RULES The Child Care Expense Benefit will be provided to reimburse your expenses incurred for providing care for your dependent children who are: 1. under the age of 15; or 2. incapable of providing their own care on a daily basis due to their own physical handicap or mental retardation. To receive this benefit, you must provide satisfactory proof that: 1. you are incurring expenses for child care while participating in Unum's rehabilitation program; and 2. payments for child care have been made to the child care provider. Child Care Expense Benefits will end on the earlier of the following: 1. the date the dependent child(ren) attain the age of 15; 2. if the dependent child(ren) are mentally retarded or physically handicapped, the date they are no longer: a. incapacitated; or b. requiring daily care; 3. the date a charge is no longer made by the child care provider; 4. the date you no longer participate in Unum's rehabilitation program; or 5. any other date payments would stop in accordance with this plan. LTD-OTR-4 (8/1/2008) 26

29 OTHER SERVICES These services are also available from us as part of your Unum Long Term Disability plan. IS THERE A WORK LIFE ASSISTANCE PROGRAM AVAILABLE WITH THE PLAN? We do provide you and your dependents access to a work life assistance program designed to assist you with problems of daily living. You can call and request assistance for virtually any personal or professional issue, from helping find a day care or transportation for an elderly parent, to researching possible colleges for a child, to helping to deal with the stress of the workplace. This work life program is available for everyday issues as well as crisis support. This service is also available to the Policyholder. This program can be accessed by a telephone number available 24 hours a day, 7 days a week or online through a website. Information about this program can be obtained through your plan administrator. HOW CAN UNUM'S SOCIAL SECURITY CLAIMANT ADVOCACY PROGRAM ASSIST YOU WITH OBTAINING SOCIAL SECURITY DISABILITY BENEFITS? In order to be eligible for assistance from Unum's Social Security claimant advocacy program, you must be receiving monthly payments from us. Unum can provide expert advice regarding your claim and assist you with your application or appeal. Receiving Social Security benefits may enable: - you to receive Medicare after 24 months of disability payments; - you to protect your retirement benefits; and - your family to be eligible for Social Security benefits. We can assist you in obtaining Social Security disability benefits by: - helping you find appropriate legal representation; - obtaining medical and vocational evidence; and - reimbursing pre-approved case management expenses. SERVICES-1 (8/1/2008) 27

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